Kalińczuk Łukasz, Demkow Marcin, Mintz Gary S, Cedro Krzysztof, Debski Artur, Ciszewski Michał, Ciszewski Andrzej, Kruk Mariusz, Karcz Maciej, Warmiński Grzegorz, Pregowski Jerzy, Chmielak Zbigniew, Witkowski Adam, Lubiszewska Barbara, Ruzyłło Witold
Department of Haemodynamics, Institute of Cardiology, Warsaw, Poland.
Am J Cardiol. 2009 Aug 15;104(4):531-7. doi: 10.1016/j.amjcard.2009.03.067. Epub 2009 Jun 18.
We used intravascular ultrasound (IVUS) to compare the expansion of drug-eluting stents (DES) implanted to treat bare-metal stent (BMS) restenosis after 3 common re-stenting strategies. A total of 80 consecutive BMS restenotic targets were re-stented either directly (n = 30, group 1) or after low-pressure (<8 atm) pre-dilation with an undersize regular balloon (n = 16, group 2) or after high-pressure (>12 atm) pre-dilation with a semicompliant balloon the same or greater diameter as the original BMS diameter (n = 34, group 3). More patients from groups 2 and 3 had diabetes mellitus. The targets in group 1 were more proximal and focal. Lesions from groups 2 and 3 were more severe. The size and deployment pressure of the DESs and the achieved angiographic results were all similar. The post-intervention minimum stent area and the percentage of expansion of DES (minimum stent area/distal reference lumen area x 100%) were, however, both significantly larger in group 3 (6.4 +/- 1.5 mm(2) in group 3 vs 5.6 +/- 1.6 mm(2) in group 1 vs 4.4 +/- 1.4 mm(2) in group 2, p <0.001; and 88 +/- 30% in group 3 vs 74 +/- 14% in group 1 vs 73 +/- 23% in group 2, p = 0.021). A post-intervention minimum stent area <5.0 mm(2) was seen in only 3 lesions in group 3 (8.8%) versus 14 in group 1 (46.7%) and 11 in group 2 (68.8%; adjusted odds ratio 0.11, 95% confidence interval 0.03 to 0.38, p <0.001). Overall, the acute lumen gain was mainly from BMS re-expansion; however, the BMS volume increased the most in group 3 (p <0.001). In conclusion, high-pressure pre-dilation leads to superior post-intervention expansion of DESs implanted to treat BMS restenosis, regardless of the original expansion because of the greater BMS re-expansion.
我们使用血管内超声（IVUS）比较了3种常见再支架植入策略后用于治疗裸金属支架（BMS）再狭窄的药物洗脱支架（DES）的扩张情况。共有80个连续的BMS再狭窄靶点接受了再支架植入，其中直接植入（n = 30，第1组），或使用尺寸小于正常的普通球囊进行低压（<8个大气压）预扩张后植入（n = 16，第2组），或使用与原始BMS直径相同或更大直径的半顺应性球囊进行高压（>12个大气压）预扩张后植入（n = 34，第3组）。第2组和第3组中有更多患者患有糖尿病。第1组的靶点位置更靠近近端且更局限。第2组和第3组的病变更严重。DES的尺寸、释放压力以及所获得的血管造影结果均相似。然而，第3组的干预后最小支架面积和DES扩张百分比（最小支架面积/远端参考管腔面积×100%）均显著更大（第3组为6.4±1.5mm²，第1组为5.6±1.6mm²，第2组为4.4±1.4mm²，p<0.001；第3组为88±30%，第1组为74±14%，第2组为73±23%，p = 0.021）。第3组仅有3个病变（8.8%）的干预后最小支架面积<5.0mm²，而第1组有14个（46.7%），第2组有11个（68.8%；校正比值比0.11，95%置信区间0.03至0.38，p<0.001）。总体而言，急性管腔增益主要来自BMS的再扩张；然而，第3组中BMS的体积增加最多（p<0.001）。总之，高压预扩张导致用于治疗BMS再狭窄的DES在干预后具有更好的扩张效果，无论由于BMS更大程度的再扩张而导致的初始扩张情况如何。
